Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
BMJ Open. 2017 Jan 31;7(1):e011916. doi: 10.1136/bmjopen-2016-011916.
OBJECTIVES: To investigate the association between rheumatoid arthritis (RA) and periodontitis with special emphasis on the role of antirheumatic drugs in periodontal health. DESIGN: Prospective follow-up study. Patients with early untreated RA and chronic active RA were examined at baseline and 16 months later. Controls were examined once. SETTINGS AND PARTICIPANTS: The study was conducted in Finland from September 2005 to May 2014 at the Helsinki University Hospital. Overall, 124 participants were recruited for dental and medical examinations: 53 were patients with early disease-modifying antirheumatic drug (DMARD) naїve RA (ERA), 28 were patients with chronic RA (CRA) with insufficient response to conventional DMARDs. After baseline examination, patients with ERA started treatment with synthetic DMARDs and patients with CRA with biological DMARDs. Controls were 43 age-matched, gender-matched and community-matched participants. OUTCOME MEASURES: Degree of periodontitis (defined according to the Center for Disease Control and Prevention and the American Academy of Periodontology). Prevalence of periodontal bacteria (analysed from plaque samples), clinical rheumatological status by Disease Activity Score, 28-joint count (DAS28), function by Health Assessment Questionnaire (HAQ) and treatment response by European League Against Rheumatism (EULAR) criteria. RESULTS: Moderate periodontitis was present in 67.3% of patients with ERA, 64.3% of patients with CRA and 39.5% of control participants (p=0.001). Further, patients with RA had significantly more periodontal findings compared with controls, recorded with common periodontal indexes. In the re-examination, patients with RA still showed poor periodontal health in spite of treatment with DMARDs after baseline examination. The prevalence of Porphyromonas gingivalis was higher in patients with ERA with periodontal probing depth ≥4 mm compared with patients with CRA and controls. Antirheumatic medication did not seem to affect the results. CONCLUSIONS: Moderate periodontitis was more frequent in patients with RA than in controls. Patients with ERA and CRA exhibited poorer periodontal health parameters when compared with controls. There was no association between antirheumatic treatment and periodontal parameters.
目的：探讨类风湿关节炎（RA）与牙周炎的相关性，特别关注抗风湿药物对牙周健康的作用。
设计：前瞻性随访研究。在基线和 16 个月后对未经治疗的早期 RA 和慢性活动性 RA 患者进行检查。对照组仅进行一次检查。
地点和参与者：该研究于 2005 年 9 月至 2014 年 5 月在芬兰赫尔辛基大学医院进行。共招募了 124 名接受牙科和医学检查的参与者：53 名患有早期疾病修饰抗风湿药物（DMARD）初治 RA（ERA）的患者，28 名对常规 DMARD 反应不足的慢性 RA（CRA）患者。基线检查后，ERA 患者开始使用合成 DMARD 治疗，CRA 患者开始使用生物 DMARD 治疗。对照组为 43 名年龄、性别和社区匹配的参与者。
结果：ERA 患者中中度牙周炎的患病率为 67.3%，CRA 患者为 64.3%，对照组为 39.5%（p=0.001）。此外，与对照组相比，RA 患者的牙周病发现明显更多，这是通过常见的牙周指数记录的。在复查中，尽管基线检查后使用了 DMARD 治疗，但 RA 患者的牙周健康状况仍不佳。与 CRA 和对照组相比，ERA 患者牙周探诊深度≥4mm 者中牙龈卟啉单胞菌的患病率更高。抗风湿药物似乎并没有影响结果。
结论：RA 患者的中重度牙周炎患病率高于对照组。与对照组相比，ERA 和 CRA 患者的牙周健康参数较差。抗风湿治疗与牙周参数之间没有关联。
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